Pectoralis major myocutaneous flap in the reconstructive surgery of the head and neck - our experience [Veliki pektoralni miokutani režanj u rekonstruktivnoj kirurgiji glave i vrata - naše iskustvo]

Rudeš, Mihael and Bilić, Mario and Jurlina, Martin and Prgomet, Drago (2012) Pectoralis major myocutaneous flap in the reconstructive surgery of the head and neck - our experience [Veliki pektoralni miokutani režanj u rekonstruktivnoj kirurgiji glave i vrata - naše iskustvo]. Collegium Antropologicum, 36 (S. 2). pp. 137-142. ISSN 0350-6134

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Abstract

The goal of this retrospective study is the evaluation of pectoralis major myocutaneous pedicle flap (PMMPF) reliability in clinical practice based on the analysis of the leading indication and postoperative complications. In the period from 2005 to 2011 at the University Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb University Hospital Center, a total number of 27 PMMPF were used in the treatment of 26 patients. Indications for flap use were upper aerodigestive tract and soft tissue defects following resection of head and neck cancer. One-stage reconstructive technique was used in all patients. Basic demographic data, clinical stage of malignant disease, indications, postoperative complications and management of flap-related complications were systematically analyzed. In 24 cases (89%) leading indication for flap use was primary defect reconstruction following head and neck carcinoma resection and in 3 cases (11%) "salvage" reconstruction following salivary fistula formation and flap-related complications. Tumor invaded skin in 2 (8%) cases, oral cavity in 1 (4%) case, oropharynx in 12 (46%) cases, larynx and/or hypopharynx in 10 (38%) cases and major salivary gland in 1 case (4%). Mucous defect occurred in 21 (81%), cutaneous defect in 3 (11%) and muco-cutaneous defect in 2 patients (8%), respectively. 16 postoperative complications (59.3%) were recorded but only one patient (4%) sustained total flap necrosis. Previously irradiated patients had significantly higher postoperative complication rate. The rate of complications requiring surgical treatment was 25%. Although the overall complication rate was substantially high, PMMPF achieved desired reconstructive goal in 96% cases. Functional and aesthetic assessment was difficult due to the small series of patients. In conclusion, pectoralis major myocutaneous pedicle flap is still safe and acceptable reconstructive method in surgical treatment of patients with head and neck tumors.

Abstract in Croatian

Cilj ove retrospektivne studije je evaluacija pouzdanosti velikog pektoralnog miokutanog režnja (VPMR) u kliničkoj praksi temeljem analize vodeće indikacije za njegovu primjenu i procjene postoperativnih komplikacija. Od 2005. do 2011. godine na Klinici za otorinolaringologiju i kirugiju glave i vrata, KBC Zagreb, ukupno 27 VPMR je primjenjeno u liječenju 26 bolesnika. Indikacije za primjenu režnja su bili defekti gornjeg aerodigestivnog trakta i mekih tkiva nakon resekcije karcinoma glave i vrata. Svi pacijenti su operirani standardiziranom tehnikom u jednom aktu. Sistematska analiza je potom izvršena prema osnovnim demografskim podatcima, vodećoj indikaciji, kliničkom stadiju maligne bolesti, postoperativnim komplikacijama te sanaciji komplikacija vezanih uz režanj. U 24 slučaja (89%) vodeća indikacija za primjenu režnja je bila primarna rekonstrukcija nakon resekcije karcinoma glave i vrata, dok je u 3 slučaja (11%) indikacija bila »spasonosna« rekonstrukcija zbog razvoja fistule i komplikacija vezanih uz režanj. Tumori su zahvatili kožu u 2 (8%), usnu šupljinu u 1 (4%), srednje ždrijelo u 12 (46%), grkljan i/ili donje ždrijelo u 10 (38%) i veliku žlijezdu slinovnicu u 1 (4%) bolesnika. Defekti su bili mukozni kod 21 (81%), kožni kod 3 (11%) i kombinirani mukozni-kožni kod 2 (8%) bolesnika. Zabilježeno je 16 postoperativnih komplikacija (59.3%) ali samo u jednog bolesnika (4%) je zabilje- žena kompletna nekroza režnja. Prethodno zračeni bolesnici su imali značajno viši postotak postoperativnih komplikacija. Broj postoperativnih komplikacija koji je zahtijevao operativni tretman je iznosio 25%. Iako je udio svih postoperativnih komplikacija bio visok, VMPR je ispunio željeni cilj u 96% slučajeva. Ocjena funkcionalnog i esteskog uspjeha je značajno bila otežana malom serijom bolesnika liječenih ovom metodom. Naposlijetku možemo zaključiti da je VPMR i dalje sigurna i prihvatljiva rekonstruktivna metoda u bolesnika oboljelih od malignih tumora glave i vrata.

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